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January 14, 2010  Vol. 362 No. 2

Audio Summary of this Issue

Perspective
93-95

One prominent feature of the current health care reform bills is a “play-or-pay” rule for employers. Bradley Herring and Mark Pauly argue that this method results in confusion and could add further inequities to our system.

95-97

Much of the current debate about expanding health insurance coverage avoids addressing an uncomfortable trade-off: with a limited budget, making benefits more generous means being able to cover fewer people. Katherine Baicker and Amitabh Chandra discuss ...

98-99

The U.S. health care system has been ranked 37th in the world. Drs. Christopher Murray and Julio Frenk ask why we spend so much to get so little.

e2

Health care reform lurches forward. The House and Senate have both passed reform bills. How well reform works in practice, however, will depend on one key difference between the two bills that has received far too little attention — how their provisions ...

e3

Chronic conditions, especially those associated with overweight, are on the rise in the United States (as elsewhere). Employers have used both carrots and sticks to encourage healthier behavior. The current health care reform bills seek to expand the role ...

e4

With no votes to spare — because every Republican stood in opposition — the normally fractious Senate Democrats cast aside their differences to pass a landmark health care reform bill by a vote of 60 to 39 on Christmas Eve, the 25th straight day of debate ...

Original Articles
101-109

In this study involving wives of active-duty U.S. Army soldiers, women whose husbands were deployed to Iraq or Afghanistan between 2003 and 2006 were more likely to receive diagnoses of depressive, sleep, anxiety, and stress disorders than were women whose husbands were not deployed.

110-117
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In this study of injured U.S. military personnel, the use of morphine during trauma care was associated with a reduced risk of post-traumatic stress disorder (PTSD) after injury. This finding suggests that optimal control of pain after serious injury may help prevent PTSD.

118-128

In this 12-week randomized trial comparing two biologic agents known to be effective for psoriasis, ustekinumab (an interleukin-12 and interleukin-23 blocker) was more effective than etanercept (an inhibitor of tumor necrosis factor α). Adverse events associated with the two treatments were similar, but the trial was not large enough and follow-up was not long enough to assess uncommon adverse events.

129-137

Preoperative biliary drainage is often performed in patients with obstructive jaundice caused by cancer of the pancreatic head, but the benefit of the procedure is unclear. This randomized trial compared 4 to 6 weeks of preoperative biliary drainage, followed by surgery, with immediate surgery alone for cancer of the pancreatic head. The drainage procedure increased morbidity and did not decrease the rate of surgical complications.

138-145
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  • Video

A donor trachea, harvested from a cadaver, was transplanted into the forearm of a recipient and wrapped in the recipient's fascia. Months later, a vascular supply to the allograft had become established, and the tracheal epithelium had repopulated with a buccal mucosa graft from the recipient. Immunosuppressive therapy was stopped, and the allograft was used to repair the recipient's tracheal defect. The graft continues to function more than 1 year later.

Review Article
146-154

    Nosocomial bacterial meningitis is most often related to either complicated head trauma or invasive procedures, such as craniotomy, placement of ventricular catheters, intrathecal infusion of medications, or spinal anesthesia. In addition, metastatic infection from hospital-acquired bacteremia occasionally leads to meningitis. The conditions are associated with different pathogenetic mechanisms and a different spectrum of microorganisms, and therefore the choice of empirical antimicrobial therapy will vary according to the condition.

    Images in Clinical Medicine
    155
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    A 47-year-old woman presented to our hospital with a 2-week history of widespread, painful lesions on her trunk and limbs (Panels A and B). Her medical history included hypercholesterolemia, diabetes, and a 10-year history of psoriasis that had been ...

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    A 45-year-old woman presented for an assessment of breathlessness. Examination revealed a biphasic wheeze. Pulmonary-function testing showed marked limitation of the inspiratory and expiratory flow rates.

    Case Records of the Massachusetts General Hospital
    156-166

    A 75-year-old man was admitted to this hospital because of the recent onset of hypertension, hyperglycemia, and edema. He had a history of prostate cancer, hemochromatosis, adrenal and thyroid nodules, and colonic polyps. The white-cell count was 17,400 per cubic millimeter with 87% neutrophils; the serum level of potassium was 2.6 mmol per liter and chloride 97 mmol per liter. Imaging studies showed pulmonary and hepatic nodules that had not been present on earlier studies. A diagnostic procedure was performed.

    Editorials
    168-170

    It is always important to capture information generated from clinical databases to advance theory and practice. This is certainly the case with two articles in this issue of the Journal. One article addresses the secondary prevention of post-traumatic ...

    170-172

    Pancreatic cancer is a common and deadly disease that is diagnosed in more than 40,000 patients annually in the United States, where it is the fourth leading cause of cancer-related death. Cancer of the pancreatic head causes biliary obstruction by ...

    172-174

    The types of allogeneic organs and tissues that can be transplanted have expanded considerably in the past three decades. In addition to organs such as liver, heart, lungs, and pancreas, the list of allografts now includes islets of Langerhans and ...

    Clinical Implications of Basic Research
    175-176

    A subgroup of luminal cells in the prostate gland of the mouse are resistant to apoptosis induced by androgen withdrawal and can be induced to form carcinomas.

    Correspondence
    177-179

    To the Editor: In the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT), Moss and colleagues (Oct. 1 issue)1 enrolled minimally symptomatic patients with severe left ventricular dysfunction, who had ...

    179-181

    To the Editor: In their study comparing the efficacy of two vaccines against influenza types A and B, Monto et al. (Sept. 24 issue)1 report that the absolute efficacy against both types of influenza was 68% for the trivalent inactivated vaccine and 36% ...

    181-182

    To the Editor: Green et al. (July 16 issue)1 report that the disclosure of a positive apolipoprotein E (APOE) genotyping result to adult children of patients with Alzheimer's disease led to no short-term increases in depression or anxiety relative to a ...

    182-183

    To the Editor: In their Video in Clinical Medicine, Malempati et al. (Oct. 8 issue)1 provide an excellent overview of bone marrow aspiration and biopsy procedures. However, I differ with some of their recommendations.

    First, the practice of rolling and ...

    183-185

    To the Editor: Human embryonic stem-cell research may lead to new methods of drug discovery, insights into mechanisms of disease, and eventually, cellular therapies. The potential benefit to patient populations may depend partially on the diversity of ...